Survivors of Pediatric Cancers Report Poor Health Despite Treatment Advances

Despite evolution of treatments and substantial improvements in survival, the self-reported health status among adult survivors of childhood cancers has not improved over 3 decades, according to a new study.

“Progress in treatment and supportive care for children with cancer has improved survival, resulting in more childhood cancer survivors,” wrote study authors led by Kirsten K. Ness, PhD, of St. Jude Children’s Research Hospital in Memphis. “However, some survivors have chronic medical conditions because of cancer or therapy that alters health status and interferes with daily life.” The proportion of survivors suffering such effects as they relate to the period when treatment was delivered was not previously known.

The new study included 14,566 adults who survived at least 5 years after initial diagnosis, treated between 1970 and 1999 and divided by decade of treatment; the median age of the cohort was 27 years. The results were published in Annals of Internal Medicine.

There was a decreasing percentage of patients reporting severe, medically significant, disabling, or life-threatening chronic conditions over time; 33.4% of those treated between 1970 and 1979 reported such conditions, compared with 25.8% of those treated in the 1980s, and 21% of those treated in the 1990s.

In spite of that decrease, patient-reported health status did not improve across treatment decades. Of those treated in the 1990s, 13.7% reported poor general health, and 15% reported cancer-related anxiety; this was higher than those treated in the 1970s, at 11.2% and 13.3%, respectively. The proportions of survivors did not change with regard to self-reported poor general health, poor mental health, functional impairment, or activity limitation.

When divided by specific malignancies, there were some changes across treatment decade. Among patients with acute lymphoblastic leukemia, 9.5% of those treated in the 1970s reported poor general health, compared with 9.9% and 13.9% in the 1980s and 1990s, respectively. This was similar for cancer-related pain and anxiety. The association between treatment decade and poor general health and pain was not significant after adjustments for treatment exposures, though this adjustment did not affect the relationship with cancer-related anxiety. Osteosarcoma survivors were also more likely to report poor general and mental health if treated later rather than earlier.

Patients with astrocytoma showed decreasing functional impairment by treatment decade, from 33.4% among those treated in the 1970s down to 18.1% in those treated in the 1990s. Adjustments for treatment exposures did not change this result. The same was true of medulloblastoma survivors.

Overall, on multivariate analysis, the relative risk of reporting poor general health with the 1970s as the reference was 1.3 for the 1990s (95% CI, 1.1–1.5). Other factors significantly associated with poor general health included female gender, current/former smoking status, and body mass index other than normal weight.

The improved survival over time is a likely reason for this trend. “Children who would have died in the earliest decade, but were alive in the most recent decade, may be those who on average would report worse later health outcomes,” the authors wrote. “These data may be important in providing opportunities to modify treatments with extreme toxicity and directing early intervention during survivorship for persons who report adverse health status.”